Carelon Clinical Appropriateness Guidelines for Radiation Therapy
Radiation Therapy
OPEN THE GUIDELINES FOR RADIATION THERAPY EFFECTIVE MARCH 13, 2022
COMING SOON RADIATION THERAPY GUIDELINES EFFECTIVE NOVEMBER 6, 2022
Proton Beam Therapy
OPEN THE GUIDELINES FOR PROTON BEAM THERAPY EFFECTIVE MARCH 13, 2022
Therapeutic Radiopharmaceuticals
OPEN THE GUIDELINES FOR THERAPEUTIC RADIOPHARMACEUTICALS EFFECTIVE MARCH 13, 2022
COMING SOON THERAPEUTIC RADIOPHARMACEUTICALS GUIDELINES EFFECTIVE NOVEMBER 6, 2022
Perirectal Hydrogel Spacer
OPEN THE GUIDELINES FOR PERIRECTAL HYDROGEL SPACER EFFECTIVE NOVEMBER 7, 2021
CPT code lists
To access the current CPT code list, please refer to the appropriate BCBS health plan provider page
- Illinois Commercial
- Montana
- New Mexico Commercial
- Blue Cross Centennial CommunitySM (New Mexico Medicaid)
- Oklahoma (look for the link to “Preauthorization Requirements Lists”)
- Texas
Archived Guidelines
Please note archived guidelines effective March 14, 2021 replaced January 1, 2021 versions. Clinical content did not change.
RADIATION THERAPY
- Radiation Therapy effective November 7, 2021 – March 12, 2022
- Radiation Therapy effective March 14, 2021 – November 6, 2021
- Radiation Therapy effective January 1 – March 13, 2021
PROTON BEAM THERAPY
- Proton Beam Therapy effective March 14, 2021 – March 12, 2022
- Proton Beam Therapy effective January 1 – March 13, 2021
THERAPEUTIC RADIOPHARMACEUTICALS
- Therapeutic Radiopharmaceuticals effective November 7, 2021 – March 12, 2022
- Therapeutic Radiopharmaceuticals effective March 14, 2021 – November 6, 2021
- Therapeutic Radiopharmaceuticals effective January 1 – March 13, 2021